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Over the next several years he had a gradual decline and developed issues with walking and swallowing. Eventually, he began having more issues with eating and frequent pneumonia. I began visiting him in the home as it as it was impossible for him to make it into the office. He had support by his wife, paid caregivers and eventually other family. Eventually we involved hospice and he was able to die in his own apartment with the support of his wife and family. During that time period i got to know his wife well. She was a very active woman, involved in her senior community. She suffered significant anxiety as her husbands disease progressed and required care for her own. I did not see her for a year. She then appeared in my schedule as a patient. She developed a memory loss. Her children were away. They were around in the summer and really couldnt provide support. Mrs. Keller continued to live fairly independently and needed to transfer an assisted level of environment. Her transition d

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